| Japanese |
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| Title | 麻酔導入時に心拍数依存性左脚ブロックをきたした一症例 |
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| Subtitle | 症例 |
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| Authors | 蔦原祥*, 武井純二**, 岩田顕**, 小野智英***, 大久保敏博**, 劔物修* |
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| Authors(kana) | |
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| Organization | *北海道大学医学部麻酔学講座, **釧路労災病院麻酔科, ***釧路労災病院循環器内科 |
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| Journal | 循環制御 |
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| Volume | 12 |
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| Number | 1 |
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| Page | 147-153 |
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| Year/Month | 1991/ |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 全身麻酔の導入時には循環動態の変動に伴い, さまざまな不整脈が認められる. 左脚ブロックは, 心室内伝導路3本のうち2本がブロックされる伝導障害で, 基礎疾患として, 高血圧症, 虚血性心疾患, 糖尿病などを伴う場合が多い, 危険な不整脈である. 今回, 術前心電図では正常伝導を示していたが, 麻酔導入時に完全左脚ブロックをきたしたために手術を中止し, 運動負荷心電図検査にて心拍数依存性左脚ブロックの診断を得たのち, 一時的ペースメーカーを装着して麻酔管理を行った症例を経験したので, 若干の文献的考察を加えて報告する1)2)3). 「症例」64才の女性, 腰部脊柱管狭窄症の診断のもとに, L4-L5内側椎間関節切除術が予定された. 既往歴としては, 40才時に腎盂腎炎に罹患, 56才時より糖尿病に罹患し, 抗生物質(セファクロル)と経口糖尿病薬(グリベンクラミド)の内服を継続していることのほかには特記すべきことはなかった. 術前検査で, 身長152cm, 体重67kg, 血圧120/80mmHg, 心拍数58回/分で, 血液, 生化学, 尿検査, 腎, 肺機能検査などに異常所見は認められなかった. 胸部X線写真上CTR 49%, 肺野は清明で, 異常は認められなかった. 入院時心電図(図1)では, 心拍数53回/分の洞調律で, 軸は+39℃, V1〜V4でT波の終末逆転, V5〜V6でT波の平低化が認められた. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Tachycardia-dependent intermittent complete left bundle branch block, temporary pacemaker, diabetes meritus, wide QRS, inverted T wave |
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| English |
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| Title | Anesthetic Management of a Patient with Tachycardia-dependent Intermittent Left Bundle Branch Block |
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| Subtitle | |
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| Authors | Sho Tsutahara*, Junji Takei**, Akira Iwata**, Tomohide Ono***, Toshihiro Ohkubo**, Osamu Kemmotsu* |
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| Authors(kana) | |
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| Organization | *Department of Anesthesiology Hokkaido University School of Medicine, **Department of Anesthesiology Kushiro Labor Disaster Hospital, ***Depertment of Cardiology Kushiro Labor Disaster Hospital |
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| Journal | Circulation Control |
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| Volume | 12 |
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| Number | 1 |
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| Page | 147-153 |
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| Year/Month | 1991/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | A case of perioperative tachycardia-dependent intermittent left bundle branch block in an 64-year-old female was reported. Although she had diabetes meritus, her preoperative electrocardiogram was within normal limits except inverted T-waves (V1-V4). Lumbar osteotomy was scheduled for lumbar spinal canal stenosis. An intravenous atropine 0.5 mg for bradycardia produced wide-QRS on her electrocardiogram at induction of anesthesia. The operation was postponed for evaluation of the wide-QRS. Tachycardia-dependent intermittent complete left bundle branch block (TlcLBBB) was diagnosed by an exercise electrocardiogram. The operation was scheduled again on the 23rd day following the first episode. A temporary pacemaker was inserted preoperatively and the Holter electrocardiogram was made during perioperative periods. Anesthesia was maintained with enfiurane/N2O and fentanyl after induction with thiamyral. Although several TlcLBBB episodes were observed during and after anesthesia, neither complete atrio-ventricular block (cAVB) nor ventricular tachycardia (VT) were noted. Her post operative course was uneventful and she was discharged on the 28th postoperative day without any complications. It is concluded that the keen monitoring of an electrocardiogram in a patient with TlcLBBB is essential during perioperative periods, and that a preoperative temporary pacemaker and a diffibrirator should be prepared during anesthesia. |
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| Practice | Basic medicine |
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| Keywords | Tachycardia-dependent intermittent complete left bundle branch block, temporary pacemaker, diabetes meritus, wide QRS, inverted T wave |
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